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  • Pediatric Dentistry

     

     Rare Report of Primary Talon and its Management

     

    Ranvitha Priya Kodali - BDS

    Intern, SRM Dental College, Chennai | TN, India

    Sreekanth Kumar Mallineni - BDS, MDS

    Consultant Paediatric Dentist, Vasan Dental Care, Banjara Hills, Hyderbad | AP, India | drmallineni@gmail.com

    Mohammed Azher Mohiuddin - BDS, MDS

    Consultant Oral-maxillofacial Surgeon, Vasan Dental Care, Banjara Hills, Hyderbad | AP, India

    Radhika Kunduru - BDS

    Dentistry, Abhiram Institute of Medical Sciences, Atmakur, Nellore | AP, India

     

     

     

    ABSTRACT

    Talon cusp refers to a rare developmental dental anomaly characterized by a cusp-like structure projecting from the cingulum area or cement–enamel junction. This condition can occur in the maxillary and mandibular arches of the primary and permanent dentitions. Talon cusp commonly seen in lateral incisor affecting permanent dentition, whilst, central incisor in primary dentition. However, the primary talon was a rare finding and its management varies based on its presentation. The purpose of the present report was to describe a case of primary talon and its management.

     

    KEYWORDS

    Talon cusp, Primary Dentition, Central Incisor.

     

     

    INTRODUCTION

    Talon cusp is a cusp-like projection or tooth like from the palatal or labial surface of an anterior tooth that extended at least half the distance from the cement-enamel junction to the incisal edge. It contains enamel, dentin and/ or pulp in maxillary or mandibular arch.1

     

    Talon cusps are very rarely reported as developmental abnormality of uncertain aetiology that affects the anterior teeth in primary dentition. A curved horn-like process and/or supernumerary cusps on the palatal surfaces of permanent maxillary central incisors were first reported in the literature almost a century ago.2 Subsequently, various names like accessory cusp, cusped cingulum, dens evaginatus, evaginated odontome, horn, hyperplastic cingulum, supernumerary cusp and supernumerary lingual tubercle have been given by different authors for this portent.3 It has also been referred to as a cusp-like projection, hyperplasia of the cingulum, palatal accessory cusp and unusual projection of the facial surface of the anterior teeth.4 Mellor and Ripa5 called this anomaly as talon cusp due to its similarity to that eagle’s talon.

     

    The projections covered by enamel may contain pulp tissue and it is possible that a talon cusp could be the ultimate expression of a dens evaginatus, hence, the term “dens evaginatus of the anterior teeth” has also been used for “talon cusp”.3,4 However, the primary talon is a rare finding and the management of primary talon varies based on its presentation, which was not discussed clearly in literature. Therefore, the purpose of the present report was to describe a case of primary talon and its management.

     

    CASE REPORT

    A 4 years and 4 months old girl attended for a routine dental check-up. Her medical and dental histories were unremarkable and she was the second child of a healthy couple. The intra-oral examination revealed that she was in the primary dentition with inadequate oral hygiene. There was evident of a talon cusp on the mesio-palatal surface of the primary maxillary left central incisor, extending from the cementoenamel junction up to two third of the crown height. A bridge of enamel connected this talon to the palatal surface of the tooth (Fig. 1).

     

    The talon cusp interfered with the occlusion (Fig. 2), otherwise talon is not irritated the tongue during speech and mastication. After discussing with patient and parent lateral grinding of the talon cusp was planned. The treatment was done in three appointments, on the first visit one third of the talon cusp was reduced and was restored with glassionomer cement (Fig. 3a), second visit partial cusp has been grinded and was restored with glassionomer cement (Fig. 3b), and third visit complete talon was removed laterally and a composite restoration was done (Fig. 3c) followed by polishing. Patient was kept under review until exfoliation of treated teeth naturally.

     

     

     

     

    DISCUSSION

    The prevalence of talon cusps in primary dentition is extremely low and till date only 62 cases of talon cusp in primary dentition have been reported in the literature.3,4 Most of the cases have been reported in primary central incisor.3 The etiology still remains unclear. Various hypotheses regarding its etiology have been put forward. Some of these are; it is supposed to be a consequence of outward folding of inner enamel epithelial cells or may be due to hyperactivity of dental lamina. Another case study suggests genetics to be a causative factor for the talon cusp based on its occurrence in a Chinese family.4 Trauma and other localized forces on tooth germ have also been held responsible for talon cusp. Lee and his co-workers3 reported that hyperactivity of cells of tooth germ may lead to development of talon cusp, which involves both genetic and environmental factors.

     

    Talon cusp has been reported to affect both genders and may be unilateral or bilateral.6-8 Literature search of reported talon cusps in the primary dentition indicated that they occurred most commonly on maxillary central incisors with unilateral presentation.3,8 The talon cusp presented in this case report occurred on the left central incisor. In the literature, most cases of a talon cusp in the primary dentition have been in Asians and boys were affected twice as often as girls were. In the present report, talon cusp affected the unilateral maxillary central incisor of a girl in a non-consanguineous family.

     

    Hattab6 classified this anomaly as type 1 (talon), type 2 (semi talon), and type 3 (trace talon). Hsu Chin-Ying and co-workers reported as major, minor, and trace talon.9 Mallineni and colleagues1 classified as facial or labial, lingual or palatal, and facial and lingual. The presented talon in this case report is type 1 or major with palatal presentation.

     

    Clinical problems that associated with the presence of a talon cusp include attrition, aesthetics, cusp fracture, displacement of the affected tooth, feeding difficulty, occlusal interference, irritation of local soft tissue, diagnostic problems of taloned tooth radiographically before eruption and caries.3,4,7,8 In the present case the talon on central incisor caused occlusal interference.

     

    Management of talon cusps include no treatment,10 sequential grinding,11 pit and fissure sealants,4 pulp therapy,5 restorative treatment,5,12 root canal treatment,13 full crown coverage,14 and extraction of the affected tooth.15 Literature pertained to permanent incisors and very few reports were described about the management of talon cusp in the primary dentition. Chen and Chen, advised no treatment or reduced the talon cusp to eliminate occlusal interference during mastication.10 Mallineni and co-workers placed fissure sealants in the developmental grooves of both talon cusps reported in their case study reported in siblings.4 Gungor and co-workers15 have chosen extraction as treatment option in case of traumatized and fractured talon cusps in primary incisors. Shey and Eytel11 reported periodic grinding method by reducing the entire bulk along the surface rather than only involving the tip for enhanced formation of reparative dentin.

     

    SUMMARY

    Primary talons are very rare in presentation. These talons causes variety of complications and this case is a good example. In the present case the sequential lateral grinding was chosen as treatment option. Management was carried out in three visits with sequential grinding of the affected left primary central incisor.

     

    REFERENCES

    1.        Mallineni SK, Panampally GK, Chen Y, Tian T. Mandibular talon cusps: A Systematic review and data analysis. J Clin Exp Dent. 2014;6:e408-13.

    2.        Mitchell WH. Letter to editor. Dent Cosmos. 1892;34:1036.

    3.        Lee CK, King NM, Lo EC, Cho SY. Talon cusp in the primary dentition: literature review and report of three rare cases. J Clin Pediatr Dent. 2006;30:299-305

    4.        Mallineni SK, Manan NM, Lee CK, King NM. Talon cusp affecting primary dentition in two siblings: a case report. Rom J Morphol Embryol. 2013;54:211-3.

    5.        Mellor JK, Ripa LW. Talon cusp:a clinically significant anomaly. Oral Surg Oral Med Oral Pathol. 1970;29:225-8.

    6.        Hattab FN, Yasin OM, Al-Nimri KS. Talon cusp in the permanent dentition associated with other dental anomalies: Review of literature and report of seven cases. J Dent Child. 1996;63:368-76.

    7.        Al-Omari MA, Hattab FN, Darwazeh AM, Dummer PM. Clinical problems associated with unusual cases of talon cusp. Int Endod J. 1999;32:183-90.

    8.        Dankner E, Harari D, Rotstein I. Dens evaginatus of anterior teeth. Literature review and radiographic survey of 15,000 teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;81:472-5.

    9.        Llena-Puy MC, Forner-Navarro L. An unusual morphological anomaly in an incisor crown. Anterior dens evaginatus. Med Oral Patol Oral Cir Buccal. 2005;10:13–6.

    10.     Chen RJ, Chen HS. Talon cusp in primary dentition. Oral Surg Oral Med Oral Pathol. 1986;62:67-72.

    11.     Shey Z, Eytel R. Clinical management of unusual case of dens evaginatus in a maxillary central incisor. J Am Dent Assoc. 1983;106:346–8.

    12.     Mader CL. Mandibular talon cusp. JADA. 1982;105:651-3.

    13.     Tsai AI, Chang PC. Management of talon cusp affecting the primary central incisor: a case report. Chang Gung Med J. 2003;26:678-83.

    14.     Rantanen AV. Talon cusp. Oral Surg Oral Med Oral Pathol. 1971;32:398-400.

    15.     Gungor HC, Altay N, Kaymaz FF. Pulpal tissue in bilateral talon cusps of primary central incisors. Report of a case. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;89:231-5.